Jama
(Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Screening and Counseling to Reduce Unhealthy Alcohol Use
This JAMA Patient Page describes the US Preventive Services Task Force ’s recent recommendations on screening and counseling to reduce unhealthy alcohol use. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

No Intimations as Yet
Unwillingly, almost unwittingly, the modern physician finds himself propelled into fields seemingly remote from the healing art. The World Health Organization ’s definition of health as “a state of physical, mental and social well-being, and not merely the absence of disease and infirmity” moves him farther into the realm of psychology, socioeconomics, and politics. Problems of birth control, resuscitation, and organ transplantation thrust him deepe r into the domain of ethics, religion, and the law. And recent neurologic and psychoendocrinologic researches edge him so close to the philosophic marshlands ...
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

The Surgery
I gave it up into those guided hands,the piece of myself that morphed somehow, and massedand grew an alien will, a hungry thing,stronger than me. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Minor Errors to Power Calculation Information
This article was corrected online. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Injection Drug Use –Associated Infective Endocarditis
In Reply In discussing the topic of injection drug use –associated infective endocarditis in our review, our intent was to highlight the lack of certainty with respect to the use of surgery and outcomes in these patients. Cardiac surgery in patients with injection drug use–associated infective endocarditis has been associated with higher mortality a nd reoperation in the first 6 months after surgery than in patients with infective endocarditis not related to injection drug use. Surgical decision-making about infective endocarditis is complicated in general. For example, approximately 1 in 4 patients with infect...
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Methods of Screening for Cervical Cancer —Reply
In Reply Mr Tang and Mr Parekh contrast the approaches for cervical cancer screening discussed in my Editorial with the screening program used in the United Kingdom and raise provocative questions about potential future directions for cervical screening. The cervical cancer prevention environment in the United Kingdom differs from that in the United States, with government audits of screening compliance, adoption of screening and management strategies based on nationally funded prospective trials and expert consensus incorporating cost-effectiveness analysis, and certification of colposcopists. Much of that is lacking in t...
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Injection Drug Use –Associated Infective Endocarditis
To the Editor Dr Wang and colleagues comprehensively reviewed diagnostic and management considerations for infective endocarditis. They appropriately raised awareness of the increasing incidence of injection drug use –associated infective endocarditis. However, we have concerns regarding statements made in reference to the surgical management of this syndrome. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Methods of Screening for Cervical Cancer
To the Editor In an Editorial, Dr Massad discussed the benefits of liquid-based cytology vs human papillomavirus (HPV) testing for cervical cancer screening and suggested that using both tests together may be necessary until a higher proportion of the population is vaccinated against HPV. Perhaps a more cost-effective approach would be to use a single screening test with a relatively high sensitivity to identify women who require further testing or more regular follow-up. In the United Kingdom, cervical screening is performed every 3 years for women aged 25 to 49 years and then every 5 years from age 50 to 64 years. Abnorm...
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Guidelines on Glycemic Targets for Persons With Type 2 Diabetes —Reply
In Reply We agree that the ACP guidance statement has ignited critical dialogue and attention to an important issue. Our rating for “establishing evidence foundations” was largely based on the lack of justification for including only the 5 long-term randomized trials referenced in existing guidelines. Prioritization of trial data over other data are part of a larger debate about the quality of evidence required to make clini cal decisions. Although we agree that trial data, when available, should be considered more heavily, it is impossible for trial data to exist for every important clinical question. Thus, ot...
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Guidelines on Glycemic Targets for Persons With Type 2 Diabetes
To the Editor Dr Tung and colleagues discussed the American College of Physicians (ACP) guidance statement on pharmacologic glycemic targets in adults with type 2 diabetes. Unlike ACP guidelines, guidance statements are not based on systematic evidence reviews and do not include a formal assessment of the quality of evidence or strength of recommendation. Guidance statements are based on quality assessment of existing guidelines and rely on evidence referenced in these guidelines. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Relapses After CAR-T Therapy
Acase study recently published inNature Medicine describes a rare mechanism of fatal relapse following chimeric antigen receptor T cell (CAR-T) therapy. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Recovery of Voluntary Movement After Paralysis
In 2 recent studies, patients with lower-limb paralysis achieved overground walking after spinal cord epidural electrical stimulation combined with intensive locomotor training. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Device Reduces Heart Failure Hospitalizations and Deaths
Patients with heart failure may develop secondary mitral regurgitation, in which a dysfunctional heart valve allows blood to leak back into the organ ’s left atrium and the lungs, further worsening the condition. Some patients remain symptomatic despite receiving maximal heart failure therapies. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Antibiotic Resistance Challenge
The CDC and the US Department of Health and Human Services (HHS) has secured commitments from more than 100 companies, professional societies, and other organizations to participate in a globalchallenge to reduce antibiotic resistance. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Alzheimer Burden
The percentage of US adults with Alzheimer disease and related dementias is projected to grow from 1.6% in 2014 to 3.3% in 2060, according to astudy by the CDC in the journalAlzheimer& Dementia. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Naloxone Accessibility Without a Prescriber Encounter Under Standing Orders at Texas Pharmacy Chains
This study evaluated naloxone accessibility from chain pharmacies in Texas 32 months after state legislation allowing pharmacists to dispense naloxone under standing orders from authorizing prescribers. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

California Provision of Naloxone Without Prescription 2 Years After Legislation Implementation
This study assesses the availability of pharmacist-furnished naloxone 2 years after implementation of legislation in California allowing provision of the drug without a physician ’s prescription. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

USPSTF Report: Screening and Behavioral Counseling to Reduce Unhealthy Alcohol Use
This systematic review to support the 2018 US Preventive Services Task Force Recommendation Statement on screening and behavioral counseling to reduce unhealthy alcohol use summarizes published evidence on the benefits and harms of screening and behavioral counseling to reduce unhealthy alcohol use among adults. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

USPSTF Recommendation: Screening and Interventions for Unhealthy Alcohol Use
This 2018 Recommendation Statement from the US Preventive Services Task Force recommends screening for unhealthy alcohol use in primary care settings in adults, including pregnant women, and providing brief behavioral counseling to reduce unhealthy alcohol use (B recommendation) and concludes that evidence is insufficient to assess balance of benefits and harms of screening and counseling for alcohol use in primary care settings in adolescents (I statement). (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Effect of a Pharmacist-Led Intervention on Inappropriate Prescriptions in Older Adults
This cluster randomized trial investigates the effects on medication discontinuation of a program in which pharmacists educated older patients taking benzodiazepines, sedative-hypnotics, first-generation antihistamines, and selective NSAIDs about why the drugs are inappropriate for their age groups and offered potential alternative treatment options. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Screening for Unhealthy Alcohol Use
In this issue ofJAMA, the US Preventive Services Task Force (USPSTF) presents a recommendation statement and an accompanying evidence review on screening and behavioral counseling interventions for unhealthy alcohol use. “Unhealthy alcohol use” refers to a spectrum from use of alcohol that increases the risk for health consequences (ie, risky or hazardous drinking) to the diagnosis of alcohol use disorder (AUD). In this update of its 2013 recommendation, the USPSTF “recommends screening for unhealthy alcohol u se in primary care settings in adults 18 years or older, including pregnant women, and providing...
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Overcoming Inertia to Improve Medication Use and Deprescribing
Inertia is a powerful force. Stopping or starting is difficult in health care as well as in other sciences. Ineffective or potentially harmful treatments are often not stopped, even years after they have been started, and effective treatments are too often not started at all. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Grief After Suicide
In this narrative medicine essay, the author mourns the suicide of young adult of a friend and relives his brother ’s suicide 30 years earlier in a stream of consiousness montage of grief and advice to succor for those left behind. (Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Highlights for November 13, 2018
(Source: JAMA)
Source: JAMA - November 13, 2018 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Monitoring Your Blood Pressure
This JAMA Patient Page describes reasons for blood pressure self-monitoring and the steps involved in the procedure. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Indications of Physical Overexertion
No one will dispute the general principle that exercise is essential to the well being of the human organism. Lack of use of a part or structure adapted to energetic functioning is likely to lead to poor nutrition and perhaps even to atrophy of the organ concerned. The phenomena of overexertion are not so generally recognized, although it would not be difficult for any physician to recall instances of damage thereby, particularly in relation to the circulatory apparatus. In other words, both overexertion and disuse of vital organs represent extremes of undesirable personal behavior. Perfect health demands a performance tha...
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Yerushalayim
  *And in the slumber of tree and stone captured in her dream,    is the city who sits solitary, and in her heart, a wall. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Diagnostic vs Management Reasoning —Reply
In Reply We welcome the opportunity to elaborate on the concept of management reasoning as discussed in our Viewpoint. We did not mean to imply that diagnostic reasoning and management reasoning are sequential. On the contrary, we agree that in practice, these typically occur in parallel and often influence one another. Indeed, naturalistic studies of clinical reasoning suggest that linear approaches, while attractive for superficial descriptions, do not match expert performance. Although the iterative nature of clinical reasoning may be particularly evident in time-pressured settings, such as intensive care units and emer...
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Diagnostic vs Management Reasoning
To the Editor Dr Cook and colleagues discussed management reasoning, an incompletely understood subset of clinical reasoning. We agree that a diagnosis is a means to an end and that diagnostic reasoning is primarily a classification task. However, we disagree with the implication that diagnostic and management reasoning are 2 distinct processes that occur in succession. We contend they often overlap and act synergistically, and we wonder whether separating them would negatively affect how these elements of clinical reasoning are studied and taught. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Stress-Related Disorders and Autoimmune Disease —Reply
In Reply The main concerns of Dr Liu and colleagues can be addressed by clarifying our study design, statistical analyses, and interpretation. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Stress-Related Disorders and Autoimmune Disease
To the Editor Dr Song and colleagues reported that stress-related disorders were associated with increased risk of subsequent autoimmune disease. Stress is an adverse event that is associated with various mental disorders and physical diseases, possibly through hypothalamic-pituitary-adrenal axis dysregulation, epigenetic modification, or the inflammatory response. The study presented several problems that require further discussion. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Medications With Depression as an Adverse Effect
In Reply Drs Agustini and Berk raise 3 primary concerns regarding our analysis demonstrating an association between the use of prescription medications with depression as a potential adverse effect and concurrent depression. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Medications With Depression as an Adverse Effect
To the Editor Dr Qato and colleagues studied common prescription drugs associated with depression as an adverse effect. The authors controlled for the number of self-reported chronic conditions and performed sensitivity analysis of patients with hypertension. However, one factor that may play a role in the results that the authors did not discuss is the severity of illness of the patients. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Medications With Depression as an Adverse Effect
To the Editor In a cross-sectional survey study, Dr Qato and colleagues found that the use of prescription medications with depression as a potential adverse effect was common. However, the authors did not take into account that most of the drugs described are used to treat conditions already linked to an increased risk of depressive symptoms. Although they investigated the relationship between hypertension and depression, they did not account for the association of depressive symptoms with pain (and subsequent use of pain killers), gastroesophageal reflux disorder (and subsequent use of gastrointestinal agents), or atopic...
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Researchers Reprogram Cells In Vivo to Restore Vision in Mice
Researchers recently succeeded in partially restoring vision in mice with congenital blindness through the activation of retinal stem cells, developing a method that could transform treatment for patients with retinal degenerative diseases that currently have no cure. The advance relies on manipulating the body ’s own regenerative capability to self-repair. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Public Health Emergency Preparedness: Globalizing Risk, Localizing Threats
Infectious diseases are a constant reality, yet it takes a shock to jolt the public ’s attention and spur political action. The past weeks saw such as a shock at busy US airports, with the emergency quarantine of 3 flights. At the same time, seemingly a world away,insecurity, weak health systems, and distrustare fueling a second major Ebola outbreak in the Democratic Republic of Congo (DRC) this year. Yet reacting to periodic shocks won ’t safeguard our collective future. Emergency preparedness requires proactive planning and funding, with US leadership pivotal. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Test Detects One in a Million Cancer Cells
An in vitrodiagnostic test was recently approved to detect minimal residual disease in patients with acute lymphoblastic leukemia (ALL) or multiple myeloma. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Preventive Migraine Drug Approved
The FDA has approved ahumanized monoclonal antibody to prevent chronic migraine headaches in adults. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

New Treatment for Certain Types of Leukemia and Lymphoma
A drug that inhibits 2 enzymes known to help support the growth and survival of malignant B cells has receivedFDA approval to treat certain adults with forms of leukemia and lymphoma. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Lowering the P Value Threshold for Statistical Significance in Published RCTs
This study evaluates primary end points in randomized clinical trials (RCTs) published in 3 major general medical journals to determine how changing theP value threshold for statistical significance from .05 to .005 could affect the interpretation of previously published RCTs. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Autism Prevalence by Age for Birth Cohorts in Denmark
This Research Letter examines cumulative incidence on autism spectrum disorder in Denmark using nationwide registered diagnosis data from 1980 to 2012 and assesses whether prevalence was stabilized. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Ambulatory Blood Pressure Monitoring
A 65-year-old woman with prior RCA NSTEMI treated with PCI presents with home BP fluctuations from
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Out-of-Office Blood Pressure Monitoring in 2018
This Clinical Update summarizes the main approaches to out-of-office blood pressure monitoring —home monitoring and ambulatory monitoring and the benefits and challenges of each in the management of hypertension. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Association of Change in Cardiovascular Risk Factors With Incident Cardiovascular Events
This cohort study uses UK Whitehall II study data to characterize changes in cardiovascular risk factors over 10 years and associations between change in risk and incident cardiovascular events among people without baseline cardiovascular disease. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Cardiovascular Disease Rates Among Young Korean Adults by 2017 ACC/AHA Hypertension Guideline Definitions
This population-based cohort study uses a national insurance database data to estimate long-term rates of cardiovascular disease among young Korean adults with elevated blood pressure and stage 1 and 2 hypertension defined by the 2017 ACC/AHA High Blood Pressure Clinical Practice Guideline. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Association Between Young Adult Hypertension and Cardiovascular Events in Middle Age
This cohort study investigates associations between blood pressure classifications defined by the 2017 ACC/AHA guidelines in adults younger than 40 years and long-term CVD events including myocardial infarction, heart failure, and stroke. (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Effect of Inorganic Nitrite on Exercise Capacity in HFpEF
This randomized clinical trial compares the effect of 4 weeks ’ administration of inhaled, nebulized inorganic nitrite vs placebo on exercise capacity in patients with heart failure with preserved ejection fraction (HFpEF). (Source: JAMA)
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research

Benefits vs Harms in Treating Young Adults at Risk of Cardiovascular
High blood pressure poses a major public health problem worldwide, including in the United States. Today, an estimated 1.13 billion people worldwide have hypertension (at the cut points of either ≥140 mm Hg for systolic or ≥90 mm Hg for diastolic blood pressure). The prevalence of hypertension has been forecast to escalate to about 1.56 billion people by 2025. These statistics provoke major concern because numerous observational studies have demonstrated a continuous and graded relations hip of systolic and diastolic blood pressure with the risk of cardiovascular disease (CVD) and chronic kidney disease. The vascular...
Source: JAMA - November 6, 2018 Category: General Medicine Source Type: research